We know that early intervention is critical
to the prevention of mental health problems and studies have shown that
interventions timed during the early years can have positive effects later in
life. Funding for children and youth services is gaining public attention and attempts
are being made to develop and evaluate the effectiveness of a great variety of
programs and services within our hospitals, clinics and research institutions. Fortunately 85-90% of children and youth in
our society are provided with a strong foundation and grow up in loving
families with basic preventive programs and services that lead to successful
lives[i].
Unfortunately, 5-10% of children and youth grow up facing challenges in their
lives – from physical health or emotional challenges, to relationship problems
at home, with their peers, or in their communities.
How are these issues being addressed? - One approach to
address mental health issues is prevention and early identification and
intervention with sound evidenced-based programs and services to prevent
ongoing difficulties later in life. Another
approach is to focus on the children and youth who have not been identified
early and have missed opportunities to benefit from needed services. One of the
interventions that have been available for many years is through child welfare
agencies using Nova Scotia’s Children and Family Services Act (CFSA). Some
think of the CFSA legislation as an intervention of last resort, and for some
it is, but it also includes provisions that can intervene at any stage of the child’s
development from birth to 18 years inclusive to try and prevent or address
mental health problems faced by children and youth.
What role can
the Child Welfare System play? - Realizing
that some children will be left out of the early attempts to introduce them to
services, attempts have been made recently to improve the child welfare system.
The Department of Community Services introduced amendments to the Children and
Family Services Act (CFSA)[ii]
in December 2015 to provide interventions that will make it possible to
introduce services even at a late stage of development.
Referrals to child welfare services require
the social worker to complete a thorough assessment of the family situation
including the physical and mental problems faced by the child as well as the
responsibility of the parent in addressing the problems. Section 12A (a-g) of
the amended Children and Family Services Act, spells out the duties required by
the social worker when investigating a referral and requires the social worker
to carry out their duties “regardless of whether the social worker has consent of a
parent or guardian of the child” [section 12A (2)]. This recognizes that some
parents may not be able or willing to cooperate with recommended treatment but
this provision ensures that the prime focus here is the welfare and best
interests of the child.
Services
to Promote the Integrity of the Family: An important part of the initial assessment
by the social worker is the need to provide services to “promote the integrity
of the family” and to enable children to remain safely in their home if at all
possible. Section 13 (1)&(2) specifically emphasizes an obligation of the
agency to take “reasonable measures to provide services” and also lists,
without limitation, the type of services that can be offered by the agency or
offered in combination with an independent community service or program. The
initial visit assessment by the social worker is to determine if the child has
been harmed or in danger and needs to be removed to a safe environment. If the
child is not in immediate danger further assessment is done to determine if the
child can remain in the home with referral to appropriate services to assist
the parent to care for their child. If referral to services does not alleviate
the parent or family issues causing the child to continue to be at risk of harm
then the agency may need to bring the situation to the attention of the court.
How
does the legislation identify children and youth who are in need of mental
health services? Using the legislation
to provide services or placement implies that the parent is not able to take
action or refuses to cooperate or is directly responsible for the child’s
condition and action needs to be taken to provide services to the child. The
legislation also signifies that the parent is expected to cooperate when
recommendations are made by medical professionals for the child’s treatment. With
respect to a child who exhibits emotional harm [defined in section 3(1)(la)],
there are amendments that relate emotional harm to the parent’s role in causing
the harm and for the parent to take specific actions such as, to “co-operate
with the provision of services or treatment to alleviate
or eliminate the harm” [section 22(2)(g)].This is to ensure that the
child gets attention for any harm or risk of harm they have received.
With
respect to a mental, emotional or developmental condition of the child that, if
not remedied, could lead to serious impairment, again the amendments require
that the parent take specific responsibility such as be available to consent
to, and cooperate with the provision of services or treatment to remedy or
alleviate the condition [section 22(2)(h)].
With
respect to the exposure of the child to violence in the home directly or
indirectly, parents have responsibilities such as to obtain services or
treatment for the child or take other measures to prevent or alleviate the
violence [section 22(2)(i)].
With
respect to children and youth under 16 years, the agency is required to provide
less intrusive child care services, defined in section 13(2), in order to keep
families together before removal of the child, if that is appropriate. There
are also situations where a child needs placement in a child caring facility and
the legislation allows the parent to enter into a Temporary Care Agreement (section 17) for the purpose of receiving
child care services or placement out of the home with the prospect of return at
a future date.
With
respect to children and youth under 16 with special needs, a parent may enter
into a Special Needs Agreement with
an agency to provide services if the parent is unable to provide the care the
child needs [section 18(1)] which includes residential services in a
child-caring facility. A child has special needs “if the child has a need that
is related to or caused by a behavioural, emotional, physical, mental or other
handicap or disorder”[iii].
Due
to the amended definition of a child, now defined in the Act as being under 19
years, [section 3(1)(e], youth between 16-18 years inclusive, can enter into a Service Agreement with an agency to receive
child-care services or placement in a child-caring facility as long as there is
no parent willing to assume responsibility for the youth [section 19(1)]. In
addition, youth between 16-18 years may enter into a written agreement with an
agency to provide for a placement or assistance in obtaining a placement [section
19A(1)].
Using the court to
provide services
– This option may be used after attempts have been made to offer and provide
services to help a parent voluntarily improve their home situation so that a
child’s physical and mental health needs are met. When voluntary intervention
has not been successful, the agency may make an application to bring the matter before the court [section 32] or
may take the child into care
[section 33(1)] and present evidence that the child is in need of protective
services as defined in section 22(2). Once before the court a plan of care for
the child is presented by the agency and a number of options are available
including, an order for supervision
of the child in the home and referral of the child or parents for “assessment,
treatment or provision of services” [section 39(4)(g)]. When there is
disagreement on the plan of care another alternative is for the court to refer
the parties to “conferencing” [section 40(1)(b)] with strict timelines to
ensure that any disputes are resolved in a timely manner. “The purpose of
conferencing is to facilitate the timely resolution of the issues that resulted
in the proceeding being commenced in a manner that is consensual and that
serves the child’s best interests” [section 40(A) (1)]. During the initial
conference the agency is required to propose a service plan for the child which
is then discussed by the parties for implementation. It is important to realize
that when the agency brings the matter to the attention of the court it is the
court, after hearing evidence that makes the final decision which will affect
the child’s future.
Conclusion – The preferred method of addressing mental health problems
is to identify them in the early years of life or as soon as they become
evident to parents or medical and educational professionals. Unfortunately, the
problems of some children are missed in the early stages and are only observed
later in childhood or adolescence. A number of interventions have been listed
to address the mental health of children and youth under the CFSA legislation. In
addition, for children and youth who cannot be cared for by their parents or
their parents are uncooperative, or have contributed to physical or emotional
harm, the agency can use the court to ensure that the child or youth is living
in a safe environment and receiving needed services. However, it is important
to state that in order for these interventions to take place it is necessary to
have adequate resources that are readily accessible within the community.
[iii] CFSA Regulations,
section 37(1)(b) ( accessed: 21/01/16) http://www.novascotia.ca/just/regulations/regs/cfsregs.htm
[ii] Bill 112, An Act to Amend
Chapter 5 of the Acts of 1990, the Children and Family Services Act CHAPTER 37 ACTS OF 2015 AS ASSENTED TO BY THE LIEUTENANT GOVERNOR
DECEMBER 18, 2015. Province of Nova Scotia
[i] Our Kids are Worth It: A
Strategy for Children and Youth. (p.13). Province of Nova Scotia
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